Real-world utilization and outcomes of systemic therapy among patients with advanced or recurrent endometrial cancer in the United States

Abstract

Objective

Evaluate systemic therapy utilization patterns and outcomes by line of therapy among patients with advanced/recurrent endometrial cancer (EC) treated in the United States.

Methods

This retrospective observational study used the Optum Clinformatics Extended Data Mart Date of Death database (1 January 2004–31 December 2019) and included de-identified data from adult patients with advanced/recurrent EC who were treated with first-line (1L) platinum-based chemotherapy and initiated second-line (2L) anti-neoplastic therapy. The index date was the date of 1L therapy initiation. The number and sequence of treatments received and the proportion of patients who received each type of treatment for each line of therapy were evaluated. To account for new drug approvals, patients first treated in 2018 or 2019 were also assessed separately.

Results

Among the 1317 patients who met all eligibility criteria, 520 (39.5%) and 235 (17.8%) patients received 3 or 4+ lines of treatment, respectively, during a median total follow-up time of 25.2 months (range, 2.5–173.3 months) following the index date. Chemotherapy, including platinum- and non-platinum-based regimens, was the most common treatment across all lines of therapy: 2L, 80.0%; 3L, 66.2%; 4L+, 80.4%. Overall, 2.5%, 2.3%, and 8.9% of 2L, 3L, and 4L + patients, respectively, received anti-program death 1 (anti-PD-1) immunotherapies. In patients first treated in 2018 and 2019 (n = 163), 9.8% of patients received anti-PD-1 immunotherapy in the 2L. In the overall population, median time to next treatment (TTNT) was 19.3, 10.5, and 8.1 months for patients undergoing 2L, 3L, and 4L treatment, respectively.

Conclusions

Among patients with advanced/recurrent EC treated with 1L platinum-based therapy in clinical practice, chemotherapy was the most common treatment choice across all lines of therapy. Immunotherapy use was low overall but increased in patients who started treatment in 2018 or 2019. Overall, median TTNT decreased as lines of therapy increased.

Keywords:

• Endometrial cancer
• immunotherapy
• platinum-based chemotherapy
• treatment patterns
• real-world evidence

Transparency

Declaration of funding

This study was supported by GSK.

Declaration of financial/other relationships

BE reports consulting fees from Janssen Scientific Affairs, Novartis, Pfizer, and Pharmacyclics. MHL reports consulting fees from Janssen Scientific Affairs, Pfizer, and Pharmacyclics. PL reports consulting fees from Actelion, Janssen Scientific Affairs, Pfizer, Pharmacyclics, and Regeneron. IG reports consulting fees from Janssen Scientific Affairs, Novartis, and Regeneron. CW reports consulting fees from Janssen Scientific Affairs. PHT reports institutional grants from GSK and Merck; and personal fees from AstraZeneca, Celsion, GSK, Iovance, Novocure, and Seagen. BE, MHL, PL, and IG, and CW are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to GSK, which funded the development and conduct of this study and manuscript. JL and JAH are current employees of GSK. EMM is a former employee of GSK. CW is a former employee of Analysis Group, Inc. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

JL, EM, JAH, PHT conceived and designed the study. JL provided administrative support. BE, MHL, PL, IG, and CW analyzed the data; all authors interpreted the data. All authors participated in writing the manuscript, provided final approval of the manuscript, and are accountable for all aspects of the work.

Acknowledgements

Medical writing and editorial assistance, funded by GSK (Waltham, Massachusetts) and coordinated by Hasan H. Jamal, MSc, of GSK, were provided by Betsy C. Taylor, PhD, CMPP, and Jennifer Robertson, PhD, of Ashfield MedComms, an Inizio company (Middletown, Connecticut).

Data availability statement

Anonymized individual participant data and study documents can be requested for further research from www.clinicalstudydatarequest.com.

Previous presentation

These data were originally presented at the American Society of Clinical Oncology Quality Care Symposium (ASCO-QCS) Annual Meeting, 24 and 25 September 2021.

Ethics statement

Optum’s Clinformatics Extended Data Mart is statistically de-identified under the Expert Determination method consistent with the Health Insurance Portability and Accountability Act (HIPAA) and managed according to Optum customer data use agreements.